Inspection on 14/06/06 for Mockley Manor

This inspection was carried out on 14th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mockley Manor 24/04/07

Mockley Manor 06/09/05

Mockley Manor 19/04/05

Mockley Manor 05/10/04

Mockley Manor 13/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mockley Manor Forde Hall Lane Ullenhall Warwickshire B95 5PS Lead Inspector Yvette Delaney Key Unannounced Inspection 14th June 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mockley Manor Address Forde Hall Lane Ullenhall Warwickshire B95 5PS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01564 742185 01564 742325 Alpha Health Care Limited Care Home 52 Category(ies) of Old age, not falling within any other category registration, with number (52) of places Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2005 Brief Description of the Service: Mockley Manor is a care home providing both nursing and residential care for up to 52 residents. The home is registered to provide care for elderly residents both male and female who are aged 65 years and above. The home is situated in a small village on the outskirts of Stratford-Upon-Avon and Henley-in-Arden. Access is via a country lane and its location is very rural. Most bedrooms are single, (5 shared rooms) with views of the surrounding countryside. There are three lounges and three dining rooms available as well as extensive gardens. The buildings are a tasteful combination of old and new build. The current scale of charges for living in this home is set at £360 to £575. Other additional charges include the hairdresser, personal shopping and newspapers. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection for this inspection year 2006/07. The manager was available throughout the inspection. The inspection visit was unannounced and took place between the hours of 12.30 pm and 09.30 pm. The Pharmacist Inspector also carried out an inspection visit as part of this inspection to assess medicine administration practices in the home. Records relating to resident care, staff training and recruitment, supervision of staff and health and safety were examined. Three relatives were seen and spoken with during this visit. Six members of the staff were spoken with, which includes care staff, kitchen staff and the home manager. A large number of the residents were spoken with during a tour of the home and fuller conversations were held with six residents. Residents and relatives were able to make positive contributions during the inspection visit. Information to inform the inspection of the outcomes for residents was also gained from observation and discussions with relatives. A pre-inspection questionnaire was completed by the home manager and returned to the Commission for Social Care Inspection (CSCI). The manager was asked to distribute questionnaires regarding the service to residents, relatives and health care professionals. The completion of these is voluntary but proves useful in assessing the views that people who live in the home or experience the service through visiting the home may have. The Commission at the time of writing this report had received five comment cards from residents and eleven responses from relatives. Information gained from the questionnaires was also used to inform this report. What the service does well: Pre-admission assessments carried out prior to the residents moving into the home were thorough and shows good practice. Staff have a welcoming attitude and approach towards residents in their care. One relative commenting that “Staff are very helpful” There are examples of a positive approach to promoting equality and diversity when delivering care. A resident who is registered blind has been assessed to determine what equipment and support could be made available to help her to socialise with other residents and improve her quality of life in the home. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are areas that the service needs to do better in: ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ Care plans must be consistently updated to ensure they reflect the current care needs of residents. Daily statements must be made which identify whether the health, personal and social care needs of residents have been met. Daily statement entries should be timed and dated and cross-referenced to detail the instructions and advice given by visiting professionals. Risk assessments must be fully completed and updated for all residents and suitable preventative care plans developed where required. The medicine management was poor and must improve to safeguard the service users who live in the home. Arrangements for distributing meals at mealtimes must be improved. Trailing electrical wiring in bedrooms needs to be reviewed to ensure that access to the rooms are safe at all times. Staffing hours worked by care staff must be reviewed and monitored to ensure that staff are fit to work at all times. A plan of action must be developed to identify how the number of staff with an NVQ 2 qualification is to be increased. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality of this outcome group is good. This judgement has been made using available evidence including a visit to the home. Potential residents undergo a thorough assessment of their needs, which will ensure their diverse needs will be met. EVIDENCE: Detailed assessment forms outlining the care needs of the three residents whose care was followed during the inspection visit were available. Examination of the information in the care plans of these residents showed that relevant information had been collected in order to make an informed assessment of their care needs. Each of the resident’s care plans were written using the information from the initial assessment. On the day of the inspection visit a relative looking for a care home for his sister was visiting the home to view, have discussions with the manager and make an assessment of the services and facilities available in the home. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 10 Other relatives spoken to were also able to confirm that they had made a visit to the home prior to accepting a place. One relative had made an unannounced visit and had found the staff to be welcoming. Carers spoken with were able to describe the admissions procedure and the importance of ensuring that the home is able to meet the needs of residents admitted. The contracts for two of the residents were seen. One document was a third party agreement between social services the resident and the home and the other detailed an agreement between the home and a privately funded resident. Current fees were included, clearly laid out and residents and relatives were aware of what additional fees were payable, which included hairdressing and some activities. The current scale of charges are £360 - £575 per week. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome group is poor. This judgement has been made using available evidence including a visit to the home. Individual care plans are not consistently updated and there is an absence of information in daily written statements, this practice does not ensure that the care delivered will be appropriate at all times. Medication records are not up to date; there are gaps in recording and information. Nursing staff knowledge about the use of medicines was poor. The current practice and lack of adequate recording puts residents at risk. EVIDENCE: Examination of three residents care plans and the process of tracking the care they received throughout the day evidenced that they received care appropriate to their assessed needs and with the residents involvement. Care plans contained signed forms for one of the three residents to indicate that they had been involved in planning their individual care. Two residents were able to confirm that they had been involved in planning and agreeing to their care. The relative of one of the residents also said that if they had any Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 12 concerns about the care that they would be able to discuss these and agree on any changes. Residents told the inspector that there had been concerns in the past about the standard of care, which was “going down.” Residents and relatives felt that this had now improved and they were much happier and were well looked after by the staff. Observation of other residents in the home and speaking with residents during lunch and during the course of the visit showed that the majority are able to make active contributions and be involved in planning their care. The three residents used in the case tracking process were able to explain their input and that of their family. There was evidence that work was needed to ensure that care plans were consistently updated. The admission details for one resident showed that there had been a progressive loss of appetite and her weight had decreased. The outcome of a nutritional assessment indicated that there was cause for concern. A care plan had not been written to demonstrate how this was to be managed. The resident felt that she had improved and was making progress. Staff were unable to confirm why a nutritional care plan had not been developed. The risk assessments for a resident, one related to nutrition and the other to falls were incomplete and had not been updated. This resident is a known diabetic is at risk of developing pressure sores and has a history of falls. In the absence of up to date risk assessments staff cannot be sure that care plans reflect the current and appropriate care needs of the resident. Daily statements made were not consistent in identifying whether the health, personal and social care needs had been met. Entries were not consistently timed and dated. Cross-referencing of visits and requests or instructions made by other professionals to the home on the care needs of residents was not always identified. Absence of this information does not provide for an effective audit trial, confirm that care has been delivered and any changes communicated to all staff. There is evidence in the care plans of access and advice being obtained from specialist nurses, which includes a local GP, optician and Dentist. One relative expressed concerns about the poor standard of service provided by the visiting Dentist and Optician. In both cases visits were not made to ensure that the dentures and glasses were suitable for the resident and fitted correctly. The glasses were giving problems and not fitting and the new dentures were also ill Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 13 fitting. The Dentist was also forwarding letters to her mother requesting monies in relation to the bill, despite the daughters contact to say that she would be paying the bill on behalf of her mother. The daughter was concerned about the impact this would have on her mother thinking she was in debt and the fact that she had not had a good service from the Dentist and Optician. Discussions with the manager helped to sort out this situation and it was agreed that the letters would not be left in her mother’s bedroom but given to the daughter. The medication room on the ground floor was too hot to safely store medicines. The home has a contract with a clinical waste company to remove unwanted medicines but the regulations concerning waste medicines had not been followed and these medicines were not stored in a locked cabinet awaiting destruction. One oxygen cylinder was not secured to the wall. There were inadequate steps to check the prescription and the medicines received into the home. In one instance one medicine had not been prescribed by the hospital but was still available to administer in the home. The checking procedures had not identified this. Handwritten Medicine Administration Record (MAR) charts were poor. One was not dated so all the information recorded was meaningless. Quantities of medicines received or balances carried over had not been routinely recorded. This made audits difficult to undertake to demonstrate that the medicines had been administered as prescribed. Audits undertaken showed that some medicines had been administered but not recorded as such or recorded as administered to the service user but had not been. Medicines were found in the trolley available for administration but there was no record on the MAR chart. The MAR chart should be the complete record of all the medicines currently prescribed by the doctor. Conversely medicines were recorded on the MAR chart that were not available to administer. Medicines that had been discontinued were also recorded on the MAR chart in some instances and had not been crossed off. Inadequate supplies of some medicines resulted in the resident not receiving their prescribed medicine. One medicine had been recorded as out of stock despite 12 more tablets being administered than actually received. A further 12 more tablets had been recorded as administered despite no further supply obtained. This indicates that the nursing staff do not check the MAR chart before the administration of medicines and do not accurately record the transaction directly afterwards. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 14 Many of the medicines had been dispensed in a Monitored Dosage System. Some blisters for two service users were kept together under one name; this may result in the wrong medicine being given to the wrong resident. Procedures for “leave” medication were poor. One lady was due to go to hospital and her morning medication had not been administered which may have been of detriment to her. Some medicines were prescribed on a “when required” basis but there were no supporting protocols detailing their use. Residents are encouraged to self-administer their own medication but they were not risk assessed as able to safely do this. Compliance checks did not take place to monitor the residents’ ability to safely take their medication. The nurse in charge at the time of the inspection had a poor understanding of the medicines she administered. The manager was to start a new auditing system to monitor the medicine management within the home. Individual staff drug audits to assess each individual nurse practice do not occur. Staff were observed treating the service users with dignity and respect during the inspection and residents were seen to interact positively with staff and other residents. Residents spoken with said that all personal care such as nursing tasks, washing, dressing and using the toilet are undertaken with privacy in mind. In one of the shared bedrooms viewed maintaining privacy and dignity would present as difficult as the screen provided stops halfway along the room when drawn and does not screen off each area fully, there is also one washbasin to be used by both residents. In another shared bedroom there was no screen provided for privacy. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. Resident’s lifestyle in the home is promoted and supported by the appointment of an activities coordinator, ongoing contact with their family and friends. Freedom for residents to exercise choice and control over their life is not always evident, the management of mealtimes varied and food was not always served in an acceptable manner. EVIDENCE: The manager has now appointed a member of staff to coordinate social and leisure activities. The residents and relatives all spoke favourably about the member of staff as he is “a likeable person” and puts on activities, which they “enjoy” and he “cheers the home up.” Residents were able to confirm that activities such as bingo and quizzes take place. One of the male residents said that gardening was an activity that he enjoyed and he had been involved in planting and looking after the tomatoes that were growing. A programme of activities that have taken place was not available to be examined. There were no activities seen to take place on the day of the inspection visit. The manager said that this was due to the activities Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 16 coordinator being away on holiday. The manager and activities coordinator are working on developing a resident-focused activity programme taking into account each resident’s wishes. One resident commented in her comment card that: “I am very pleased that activities for residents have started again at Mockley Manor. There were none at all for a very long period of time, which was not good for the residents as days are very long and staff are too busy to stop and chat.” Other residents felt that there is room for improvement and that suitable activities are only provided sometimes. Comment cards were also received from relatives and they included comments on activities in the home: “I would like to see residents who are able being taken out regularly.” “Since the recent appointment of an entertainments co-ordinator the overall atmosphere in the home is more vibrant.” One of the residents registered as blind has equipment and support available to her, this includes a modified telephone and radio, is a member of the blind club and has access to ‘talking books,’ tapes. The resident is also encouraged and supported to socialise with other residents by taking part in activities in the home such as bingo and quizzes and eating her meals in the dining room with other residents. This approach provided an example of how the home meets and promote equality and diversity when delivering care. Relatives and friends were seen to visit the residents on the day of the inspection. Three visitors spoken with during the inspection visit said they are able to come and see their relative at any time and are always made to feel welcome. Two residents commented that their “family comes to see them every day”. The care home is in a very rural location but does have some community from the local community, which includes the local church. There was no evidence available to confirm that there are planned visits out into the community or entertainment is brought into the home. Residents spoken with said that they are able to express their choices in when they go to bed or get up in the morning. During the visit some residents were in their bedrooms watching television or reading the newspapers, others sat in the lounge or conservatory area. Some residents sat as group and this tended to be people with whom they are familiar with and have developed a Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 17 friendship. There are some residents who have high dependency needs and there is some element of routine to their care. The inspector ate lunch with six of the residents at this inspection one of which was one of the residents involved in the case tracking process. Some of the residents said that the food was good, with choices available. When asked some residents knew what was on the menu others did not know. The menu for lunch was chicken, or fagots served with sprouts, cauliflower, potatoes and gravy. Menus seen and examined were found to be well balanced and varied. One resident did not like any of the choices on offer and was given a meal of her choice. The meals served in the dining room was well presented and tasty, this was let down by the following practices observed: • Condiments were not available on the dining table and gravy was added to meals and it was not obvious that residents were asked if they wanted gravy. Meals were taken on trays to residents who had chosen to stay in their bedroom and to those who were in bed due to their care needs and needed help with feeding. Some of the food being delivered on trays had plate covers but some meals were transported without a cover. Meals for two residents who required help with feeding were transported on the same tray and while the carer fed one resident the other meal was left on the tray in the room of the resident who was being fed first. • • The above did not show examples of good practice to demonstrate how choice is offered to residents related to daily living activities. The methods in which meals were transported would result in the food offered being cold and be unappetising for the resident and also the food is open to the air, which could result in contamination. Responses received from five residents through comment cards identified that two of the five residents liked the food sometimes commenting: “Would be nice to have more choice at main meals, only alternative is salad, which I can’t eat. Roast beef meal and braising steak is excellent.” Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to this service. Residents feel safe and listened to. EVIDENCE: A complaints procedure is available to all residents and other visitors to the home. Brief details outlining the compliant procedure can be found in the service user guide and on display in the reception area of the home. Residents spoken with which includes two of the residents involved in the case tracking process said that they would make their concerns known to certain staff with who they are familiar or to the manager of the home. Relatives said that they were able to speak to the staff and manager if they were not happy. Two complaints have been received by the home since the last inspection. Concerns raised were related to standards of care, lack of attention to residents’ appearance, lack of attention to personal care needs, poor staffing levels, which were worse at weekends, lack of activities and resident’s clothing going missing. Both complaints had been investigated and resolved to the satisfaction of the complainants. The investigation details for one of the complaints were not available for inspection. One relative commented that when they have complained in the past it has been sorted out promptly. Through discussion staff they were able to explain Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 19 how they would address any complaints or concerns that they received and gave examples of complaints they had received and explained how they had dealt with them. Residents are encouraged and supported to exercise their legal rights. Access is available to advocacy services and leaflets/notices are available informing residents and visitors of the facilities available. Two relatives spoken to said that they felt that their relative was safe in the home. A resident commented on her comment card that she did feel safe until a male resident moved in next door to her. On the day of the inspection a conversation with the resident identified that the situation has now improved and she feels more settled. A procedure for responding to allegations of abuse is available with clear guidance for staff to follow. Training records showed that some staff had attended recent adult protection training sessions. Staff spoken to had a good understanding of the action to be taken if an allegation was made. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the home. Improvements are ongoing in the home to ensure the environment is suitably presented to ensure safety, maintenance, comfort and cleanliness, which should increase the experience of quality of life for residents. EVIDENCE: The home was found to be clean and free from offensive odours on the day of the inspection visit. The majority of resident’s bedrooms were personalised with some of their own furniture, pictures and other personal possessions. Two resident’s liked to have a lot of their possessions around in both cases the bedrooms had been arranged to ensure that these were accommodated safely. The three residents involved in the case tracking process liked the fact that their bedroom was personalised and said that this made them feel comfortable and reassured. One resident spoken with had been supported by her family to Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 21 decorate her bedroom and this she said had helped her feel more at home. A relative commented that needed a chair that she could be more comfortable in. In two bedrooms one of, which was a shared bedroom there was trailing electrical wiring. The plans for major development, which involved the building and refurbishment of an additional eight bedrooms to the home has been completed. Viewing these bedrooms found that they were well furbished and presented to a high standard. Aids and equipment are provided these were of a satisfactory quality and records were seen to confirm that they had been regularly serviced. The maintenance man had ensured that maintenance work was up to date. The gardens are accessible and tidy and residents are encouraged to be involved in gardening projects, which include growing vegetables. A visit by the Stratford –on-Avon District Council Environmental Health department on 2 November 2005 the outcome was overall good but identified some areas for improvement. The manager advised that action has been taken to address the improvements needed. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the home. Staff are employed in sufficient numbers but the lack of suitably qualified and trained staff and staff working long hours does not ensure that residents are in safe hands at all times. EVIDENCE: Staffing continues to be stable in respect of the number of staff on duty, with a decreased number of agency staff being used. Staffing is divided between the residential and nursing floors. Duty rotas for the period 13 February 2006 – 19 March 2006 and for the week commencing 12 June 2006 were examined. A number of rotas show that some staffing working between 42 and 60 hours per week. One member of nursing staff worked a long day shift of 12 hours and then straight onto a night shift of a further 12 hours, working a total of 24 hours without a break. This practice puts the member of staff at risk of making mistakes due to tiredness and therefore put residents in her care at risk. Discussion with the manager indicate that night duty are ‘waking shifts’ and normal contracted hours worked per week are between 36 and 42 hours. Staff working increased number of hours per week indicates that there are vacancies Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 23 in the home. The manager was unable to confirm that monitoring takes place for those staff working long shifts and over the normal contracted hours per week. Comments received from one resident said that she felt that foreign staff employed in the home do not always understand her needs. On the day of the inspection the resident was able to explain that this situation had now improved. Overall this resident enjoyed living in the home. A comment received from a relative said that some new staff don’t speak English. One resident commented in the comment card that when staff are in the new extension the bedroom call bells in the older building of the home could not be heard. Testing the alarms on the day of the inspection found that the alarm could be heard. Alarm calls were answered promptly during the inspection. A comment from a relative identified that the ‘call button’ is within reach for her relative. A further resident commented that “There is a lot of change of staff and seem short staffed at times.” Comments about staffing was also received from relatives: “There seems to be a big turnover of staff.” “The home did go through a phase of staff shortage but of late it does seem to be better these last few weeks.” The induction programme ensures that new staff are given the right information to be able to do their jobs well. A training plan has been implemented to ensure that training is provided to staff throughout the year. There are only two care staff trained to NVQ level 2 in care, which although there is one trained nurse on duty at each shift makes the percentage of trained care staff available in the home to be only 10 . Statutory training is up to date and records and staff spoken with were able to confirm attending fire safety, COSHH, infection control and Moving and Handling. Other training attended and planned includes drug administration, elder abuse, falls management and customer care. Staff spoken with were clear about their role, knew what was expected from them and showed a good understanding of the residents in their care. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 24 At this inspection visit the files of three members of staff on duty at the time of the inspection visit were examined. All files contained the relevant information to confirm that appropriate checks had been carried out to ensure that the employees were considered safe and suitable to work with vulnerable adults. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements are improving the quality of the service for residents. Some practices need to be reviewed and monitored to evidence that the welfare and interests of residents are consistently protected and safeguarded. EVIDENCE: A new manager for the home has been appointed and is gradually making changes in the home. The manager is currently undertaking the ‘Registered Manager’s Award, which she is due to complete in July 2006. The manager has not yet forwarded an application to the Commission for Social Care Inspection to be considered for the Registered Manager role. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 26 Residents and relatives were aware of the new management structure of the home. One relative said that the atmosphere in the home was relaxed and they noticed that attempts are made to include the residents either directly or through their relatives in changes to be made in the home. Staff appreciated the new management style, and felt it had made the working environment more comfortable, which meant that there was a better atmosphere for residents. There was no evidence that a structured approach to quality assurance had been implemented. The registered manager does not routinely carry out audit of systems and practices carried out in the home. The home manager undertakes random audits of drugs, care plans and walkabouts with the maintenance man and housekeeper. Monies are held by the home on behalf of a number of residents for safekeeping and are stored safely and securely in individual packets. Records are held of all financial transactions, but individual receipts are not consistently maintained for all monies spent on behalf of the residents. For example individual receipts for payments to the hairdresser or individual money spent on shopping were not available. A till receipt or other documentary evidence confirming a financial transaction had occurred should be available, therefore practices are unsafe. The retention of individual receipts supports evidence that residents’ finances are protected and facilitate access to personal records, in accordance with the Data Protection Act 1998. Records examined include maintenance, contracts and servicing documentation for electrical equipment and gas. Resident aids and equipment have also been serviced, this includes hoists and baths. Maintenance work is up to date, which include fire records and electrical tests. A number of other bedrooms were viewed at the time of inspection visit. In two bedrooms one of, which was a shared bedroom there was trailing electrical wiring this presents as a trip hazard for staff and residents. Staff said that they had received supervision. Records were not made available to the inspector to evidence and confirm that staff are appropriately supervised. Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The manager and registered provider must ensure that daily records are detailed dated and timed to demonstrate that individual residents health, personal and social care needs have been met thus providing details for ongoing review and a proactive audit trail. The manager and registered provider must ensure that care plans are consistently updated to reflect all the current care needs of the residents. The manager and registered provider must ensure that risk assessments are fully completed and updated for all residents. Where a risk is determined a care plan must be devised describing the actions to be taken to minimise the risk. The manager and registered provider must ensure that advice received from health care professionals is detailed, crossreferenced in care plans and acted on or the reasons for not doing so documented. DS0000004322.V290896.R01.S.doc Timescale for action 31/08/06 2 OP7 15, Sch.3 31/08/06 3 OP8 12, 13 Sch.3 31/08/06 4 OP8 13 31/08/06 Mockley Manor Version 5.2 Page 29 5 OP9 13(2) The manager and registered provider must arrange for the installation of an air conditioning system in the ground floor medication room is required to ensure that all medicines are stored below 25°C at all times to comply with their product licences. 04/08/06 6 OP9 13(2) The manager and registered 04/08/06 provider must purchase a maximum, minimum and current thermometer and the three medicine refrigerator temperatures recorded. The temperature must lie between 2° and 8°C at all times to guarantee their stability. The manager and registered provider must ensure that medicines awaiting destruction are not removed from their packaging and the clinical waste bin must be stored in a locked cabinet. The manager and registered provider must implement a system to check the prescription prior to dispensing and to check the dispensed medicines and MAR chart upon receipt against the original prescription. All new service uses medicines must be checked with their doctor or last prescription at the earliest opportunity. The manager and registered provider must ensure that all medicines that are no longer required are removed from the trolley and deleted from the MAR chart. 04/08/06 7 OP9 13(2) 8 OP9 13(2) 04/08/06 9 OP9 13(2) 18/07/06 Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 30 10 OP9 13(2) The manager and registered provider must ensure that medicines are ordered in time and are available to administer so no service user goes without their prescribed medication. Medicine must only be administered to the service user they are prescribed and dispensed for. 18/07/06 11 OP9 13(2) 12 OP9 13(2) The manager and registered 18/07/06 provider must ensure that the start date, the correct drug name and dose, the quantities of all medicines received and balances carried over are recorded on MAR charts. It must record the complete, current drug regime for each service user. 18/07/06 The manager and registered provider must ensure that staff refer to the MAR chart before any administration and signed directly after each transaction or the reason for nonadministration recorded. The right medicine must be available to administer and be administered to the right service user at the right dose at the right time as prescribed by the doctor. The manager and registered provider must ensure that any service user wishing to self administer their own medication must be fully supported and a full risk assessment must be undertaken to assess the service user and regular compliance checks undertaken and documented to confirm safe administration. 13 OP9 13(2) 18/07/06 Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 31 14 OP9 13(2) 15 OP9 13(2) 16 OP9 13(2) 17 OP10 12(4)(a) 18 OP15 16(2)(i) The manager and registered provider must undertake staff drug audits before and after a medicines round to confirm staff competence in medicine management and appropriate action must be taken if these fail. The manager and registered provider must ensure that “when required” protocols are written for all medicines prescribed to be used occasionally. Procedures for service users to take medication when they are absent from the home on leave must be reviewed. The manager and registered provider must ensure that further training is provided for nursing staff on the indications, general side effects and special requirements of the medicines the nurses administer. The manager and registered provider must ensure that the care home is conducted in a manner which respects the privacy and dignity of residents: • Separate living space must be identified in shared bedrooms and rooms organised to ensure that the privacy and dignity of individual residents is protected at all times. The manager and registered provider must review the practice at mealtimes to ensure that meals are presented to residents in a safe and timely manner: • Individual meals for residents requiring support with feeding must be taken to the specific bedroom of the resident for who the meal is intended and at the time that the resident is to be fed. DS0000004322.V290896.R01.S.doc 04/08/06 04/08/06 04/09/06 30/09/06 31/08/06 Mockley Manor Version 5.2 Page 32 • 19 OP27 13(4)(c) 20 OP28 18 21 OP33 24, 26 22 OP35 9(a) 23 OP36 18(2) 24 OP38 13, 23 Meals should not be transported or left uncovered. The manager and registered provider must risk assess the number of hours worked by staff to ensure there are no risks to the health and safety of the residents or staff. The manager and registered provider must provide an action plan, which details plans for increasing the number of care staff who have a NVQ 2 qualification. The manager and registered provider must ensure that a suitable system is established for reviewing and improving the quality of care, provided in the home. The outcome of these must be shared with the Commission and reports available for inspection. The manager and registered provider must maintain records of the purpose for which residents’ money was used and retain receipts for items or services purchased on behalf of the resident. The manager and registered provider must ensure that all persons working at the care home are appropriately supervised. Clear and informative records must be maintained and available for inspection. The manager and registered provider must undertake environmental risk assessments so as to ensure that all areas of the home are safe for the residents and staff to use. This must include an assessment of residents bedrooms particularly the trailing electrically wires. DS0000004322.V290896.R01.S.doc 31/08/06 31/08/06 30/09/06 31/08/06 30/09/06 30/08/06 Mockley Manor Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Each service user medication dispensed in the MDS must be separated by individual dividers for each service user to reduce the risk of the wrong service user being administered the wrong medicine. It is advised that all entries in the Controlled Drug register use the 24 hour clock. 2 OP9 Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mockley Manor DS0000004322.V290896.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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